Screen Spaces

My bachelor’s thesis, written as part of an interdisciplinary cooperation between University Hospital Cologne and KISD — Köln International School of Design at TH Köln, examines the interplay of image, space, and action in robot-assisted surgery and develops design perspectives on the relationship between design and medicine. It focuses on the Da Vinci® surgical system by Intuitive Surgical, which University Hospital Cologne uses for minimally invasive procedures.

Minimally invasive surgery confronts surgeons with an increasingly complex assemblage of technical apparatuses, imaging techniques, machine processes, and interpersonal interactions. With a surgical assistance robot in use, these entanglements tighten further: the Da Vinci system is modular, its components are distributed throughout the operating room, and this spatial arrangement alone results in an altered division of roles and tasks among the surgical staff. Facing away from the patient, the surgeon works at a control console, looks into a stereoscopic display, and guides instruments they never touch; the console captures their hand movements and relays them as digital signals to the endoscopic instruments in the surgical field. Action and perception are thus mediated entirely through images: the system allows the surgeon to feel present inside the patient while separating them from the patient farther than any other surgical instrument.

While medical studies seek to demonstrate the benefit of such systems, questions concerning the image-space structure and the field of action between the system and the surgical team remain largely unaddressed. How is the surgeon’s perception structured by the physical-digital operating environment, what actions does it call for, and which senses apart from sight are engaged?

I pursued these questions with audiovisual media: video recordings in the operating room, time-lapse analyses of the surgeon’s posture at the console, and an overlay of the hand movements at the console with the movements of the instruments inside the abdomen. In this overlay the surgeons see their own hands working in unison with the endoscopic instruments. Through these image and video analyses the thesis shows which processes of translation and transformation underlie access to — and intervention in — the human body in minimally invasive robot-assisted teleoperations. It thus reveals the conditions and possibilities of these complex human–machine interactions and exposes the constraints the surgical system imposes on perception and action. In the course of this work I noticed that surgeons, seated at the console, rest their arms on the armrests for only about 20 per cent of the time.

The questions opened here do not end with the thesis: the research project Robotic Operations took up the observation at the console, and the essay Beyond Boundaries carried them further into the exteriorisation of the surgical gesture.

The thesis was written between November 2018 and July 2019 in the field of design theory and research at KISD, supervised by Prof. Dr. Carolin Höfler.

Cooperation partners: Univ.-Prof. Dr. Christiane Bruns, Director of General, Visceral, and Cancer Surgery, University Hospital Cologne · Priv.-Doz. Dr. Hans F. Fuchs, Head of Robot-Assisted Surgery, University Hospital Cologne · Prof. Dr. Carolin Höfler, Design Theory and Research, KISD, TH Köln

Shown at: Kölner Designpreis 2019 (nomination) · KISD Parcours 2019 · GfM annual conference “Medien-Materialitäten”, University of Cologne